Pre-registration allows our office to better prepare for your visit. It will alert Dr. Garza of additional medical issues (if applicable) and provide us with your dental and medical insurance information. By completing the registration online, we can verify your insurance prior to your appointment so that we can discuss the financial aspects of your treatment during your visit.
You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Memorial & Maxillofacial Surgery will do everything that we can to make the registration process as easy as possible. We use DSN dental software with Truform online registration. Please click the link below to register for your appointment.
If you do not have access to a computer or do not wish to register online please arrive at our office a full 30 minutes prior to your appointment and we will have registration papers available.
Additional forms you will need for your appointment. Please click on each form to complete and bring with you to your appointment.
Insurance Verification additional dental (This form is required by your dental insurance provider)
Authorization for Release of Information to Family Members (HIPAA Compliance)
PPN (Your copy, you do not need to print) (HIPAA Compliance)
Patient Acknowledgement of Receipt of Privacy Practice Notice (HIPAA Compliance)
Registration (Print this ONLY if you did not complete the ONLINE REGISTRATION)